Peritonitis is a major cause of morbidity in peritoneal dialysis patients; however, Aeromonas caviae rarely causes peritonitis in these patients. We report peritonitis due to A. caviae in a 72-year-old male with end-stage renal failure who had been undergoing automated peritoneal dialysis for 1 year. The white blood cell (WBC) count in the peritoneal fluid was 2,722/mm3 with 85% neutrophils. Gram staining of the peritoneal fluid yielded Gram-negative rods. Empirical antibiotic therapy with ceftriaxone was initiated intraperitoneally. However, drug sensitivity testing revealed that the organism was resistant. On the third hospital day, A. caviae was cultured from the peritoneal effluent, and the antibiotic regimen was switched to ciprofloxacin. The patient recovered rapidly and the WBC count of the peritoneal effluent decreased. He was discharged and the intraperitoneal ciprofloxacin therapy was continued for 14 days. The peritoneal catheter was not removed.
Aeromonas ; Aeromonas caviae ; Animals ; Ascitic Fluid ; Catheters ; Ceftriaxone ; Ciprofloxacin ; Guinea Pigs ; Humans ; Kidney Failure, Chronic ; Leukocytes ; Male ; Neutrophils ; Peritoneal Dialysis ; Peritonitis

BACKGROUND: To elucidate the clinical presentation, antimicrobial susceptibility, and prognostic factors of monomicrobial Aeromonas bacteremia in order to determine the most effective optimal therapy. MATERIALS AND METHODS: We reviewed the medical records of Aeromonas bacteremia patients for the period January 2000 to December 2013 in a retrospective multi-center study. RESULTS: A total of 336 patient records were reviewed, with 242 having community-acquired bacteremia. The major clinical infections were of the hepatobiliary tract (50.6%) and peritonitis (18.5%), followed by primary bacteremia (17.9%). The infections usually occurred in patients with malignancy (42.3%), hepatic cirrhosis (39.3%), or diabetes mellitus (25.6%). High antimicrobial-resistance rates (15.5% for ceftriaxone, 15.5% for piperacillin/tazobactam) were noted. However, resistance to carbapenem and amikacin was only 9.8% and 3.0%, respectively. Aeromonas hydrophila (58.9%) was the most common pathogen, followed by Aeromonas caviae (30.4%). The severity of A. caviae bacteremia cases were less than that of A. hydrophila or Aeromonas veronii bacteremia (P <0.05). A. hydrophila showed higher antimicrobial resistance than did other Aeromonas species (P <0.05). Patients with hospital-acquired bacteremia were more likely to have severely abnormal laboratory findings and relatively high antimicrobial-resistance rates. Mortality was associated with metastatic cancer, shock, delayed use of appropriate antimicrobial agents, increased prothrombin time, and increased creatinine level (P <0.05). CONCLUSIONS: Aeromonas species should be considered one of the causative agents of bacteremia in patients with intra-abdominal infections or malignancies. Although ceftriaxone-resistant Aeromonas bacteremia was not statistically related to mortality in this study, it was associated with severe clinical manifestations and laboratory abnormalities. Appropriate antibiotics, including carbapenem, should be administered early, especially in Aeromonas bacteremia patients with shock and impaired renal function.
Aeromonas caviae ; Aeromonas hydrophila ; Aeromonas* ; Amikacin ; Animals ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteremia* ; Ceftriaxone ; Creatinine ; Diabetes Mellitus ; Guinea Pigs ; Humans ; Intraabdominal Infections ; Korea* ; Liver Cirrhosis ; Medical Records ; Mortality ; Peritonitis ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Shock

Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis. Based on our current understanding of SBP, the most common etiologies for SBP in cirrhosis are Enterobacter and Streptococcal species. Th e Aeromonas species are ubiquitous in fresh or sea water. Aeromonas caviae is never identified as etiology in cases of SBP. A patient, who had a history of liver cirrhosis related to chronic hepatitis B virus infection for 1 year, presented with diarrhea. He had diarrhea 1 week later returned from coastal city. He was hospitalized and treated with norfloxacin after 7 days of severe symptoms, including fever, abdominal distention, and diarrhea. Analysis of the ascitic specimen revealed a white-cell count of 4.42 × 109 cells/L with 88% neutrophils. Analysis of stool specimen showed a white-cell count of 60 cells per high-power field. Th e patient started the injection of cefriaxone at a dose of 4 g/d. However, the situation was not improved. Th ree days later, stool and ascitic fluid culture showed positive for Aeromonas caviae. Antibiotic susceptibility testing revealed that imipenem, meropenem, amikacin, and cefoperazone-sulbactam were highly sensitive to the Aeromonas caviae. However, the bacilli resisted to ceftriaxone, ceftazidime, ampicillin-sulbactam, levofloxacin, and sulfamethoxazole. Ceftriaxone was then switched to imipenem. The patient was fully recovered 14 days later. Aeromonas caviae is a rare pathogen of SBP in cirrhosis. It resists to third-generation of cephalosporin and fluroquinolone, which are of frequently used dependent on clinical experience. It needs a special attention.
Aeromonas caviae ; Anti-Infective Agents ; Ascitic Fluid ; Gram-Negative Bacterial Infections ; pathology ; Humans ; Leukocyte Count ; Liver Cirrhosis ; Male ; Microbial Sensitivity Tests ; Peritonitis ; microbiology ; pathology

This study aimed to compare the clinical presentations of Aeromonas hydrophila, A. veronii biovar sobria and A. caviae monomicrobial bacteremia by a retrospective method at three hospitals in Taiwan during an 8-yr period. There were 87 patients with A. hydrophila bacteremia, 45 with A. veronii biovar sobria bacteremia and 22 with A. caviae bacteremia. Compared with A. hydrophila and A. veronii biovar sobria bacteremia, A. caviae bacteremia was more healthcare-associated (45 vs 30 and 16%; P = 0.031). The patients with A. caviae bacteremias were less likely to have liver cirrhosis (27 vs 62 and 64%; P = 0.007) and severe complications such as shock (9 vs 40 and 47%; P = 0.009) and thrombocytopenia (45 vs 67 and 87%; P = 0.002). The APACHE II score was the most important risk factor of Aeromonas bacteremia-associated mortalities. The APACHE II scores of A. caviae bacteremias were lower than A. hydrophila bacteremia and A. veronii biovar sobria bacteremia (7 vs 14 and 16 points; P = 0.002). In conclusion, the clinical presentation of A. caviae bacteremia was much different from A. hydrophila and A. veronii biovar sobria bacteremia. The severity and mortality of A. caviae bacteremia were lower than A. hydrophila or A. veronii biovar sobria bacteremia.
APACHE ; Adult ; Aeromonas caviae/drug effects/*pathogenicity ; Aeromonas hydrophila/drug effects/*pathogenicity ; Aged ; Aged, 80 and over ; Bacteremia/complications/drug therapy/*microbiology/mortality ; Cross Infection/microbiology ; Female ; Gram-Negative Bacterial Infections/complications/drug therapy/*microbiology/mortality ; Humans ; Liver Cirrhosis/microbiology ; Male ; Middle Aged ; Retrospective Studies ; Shock, Septic/microbiology ; Taiwan ; Thrombocytopenia/complications ; Young Adult